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Background and historical development of PAHO Mental Health Program
Jorge Velasco Alzaga, was appointed as Regional Adviser, a position he held until During his tenure, Dr. Velazco Alzaga focused primarily on conducting a situation analysis of mental health in the Region. To this end, he visited every country in the Region and noted the existing programs, active psychiatric care services, and psychiatry education programs offered at the different universities.
He also visited the preihspanicos of the psychiatric institutions and pprehispanicos their deplorable conditions. This last organization issued a grant for compiling all existing psychiatry and mental health laws in Latin America and the Caribbean.
Support was also provided for two subregional mental health seminars, which were attended by representatives from the mental health departments and programs of the countries in the Region. Using the available information, which focused primarily on the availability of beds in psychiatric hospitals, rates of mortality associated with mental disorders, and institutional admissions, an initial quantitative analysis of problems related to psychiatric care in the Region was conducted.
At both subregional meetings, hospitalization in psychiatric institutions was criticized for the first time, and it was recommended that psychiatric care be included in public health systems and activities. Between July and OctoberDr. Velasco Alzaga and finishing the execution of the aforementioned grant from the National Al of Mental Health. The compilation of legislation was also completed. A directory of psychiatrists was created and a survey of psychiatric institutions was made with the collaboration of Latin American specialists.
Seminar on Mental Health in the Caribbean, Kingston, Final report; Washington, DC: At this meeting, greater emphasis was placed on a comprehensive approach to mental health as opposed to the more restrictive view of psychiatric care, and psychiatric hospitals were more directly criticized.
Indeed, one of the noteworthy final recommendations urged that no more psychiatric hospitals be created and that alternative services to treat mental illness be offered as part of public health programs.
Reports on the three subregional seminars mentioned above served as the basis for developing national mental health programs under the ministries of health in several countries. The idea that promoting changes in psychiatric care was convenient and necessary was gradually gaining ground, even though the time had yet not come for this to translate into specific stances or regional programs.
Nevertheless, over the two decades in question, PAHO increased the number of consultancies on the organization of mental health services and developed lsiquiatria fellowships policy for training outside the countries al focused on the public health approach to mental health, leaving the work of psychiatric specialization to the countries themselves.
PAHO/WHO | Background and historical development of PAHO Mental Health Program
Administration of Mental Health Services]. The main objective of the meeting was to reach an agreement on the changes needed to modernize psychiatric care and promote broader, more comprehensive mental health activities. A consensus was reached during this forum on the need to shift away from the classic insane asylum model and to put an end to custodial practices. Recommendations were made for integrating mental health programs into the public health context and for promoting the participation of communities, patients, and family members in the planning and delivery of services, as well as for amending existing mental health legislation.
Other community mental health approaches also bear mentioning: Unfortunately, the majority of these experiences were short-lived due to a lack of continuity in funding Levav I, editor. Temas de salud mental en la comunidad [Mental Health Issues in the Community].
Over the course of these two decades, training for mental health professionals at the undergraduate and specialty levels was a priority in the PAHO mental health technical cooperation program. To this end, close contact was maintained between the medical schools, the schools of public health, and psychiatry residency programs.
Between andseveral technical meetings on mental health education were held, involving professors and subject specialists. Another important aspect of the Regional Mental Health Program involved neurological diseases with a major psychological component.
Special emphasis was placed on the prevention and control of epilepsy and mental retardation intellectual disabilitiesand the U. National Institutes of Health provided cooperation in this area. A Manual for Health Workers].
An international epidemiological study on the prevalence of epilepsy in Chile, Colombia, Cuba, Mexico, and Venezuela was also promoted. During the s and s, the prevention and control of alcoholism and drug dependency were major components of the PAHO Mental Health Program, meaning that a regional adviser was permanently available for collaboration on this topic.
Technical and financial support from the U. Technical and financial assistance was also provided to the Costa Rican National Institute on Alcoholism. At this event, actions were proposed for the development of regional subprograms on: The launch of the Regional Initiative for the Restructuring of Psychiatric Care in Latin America during the Caracas Conference in Venezuela, held between 11 and 14 Novemberwas an historic event in this period.
The highlight of this event was a Declaration that established the principles to advance reform in the Hemisphere.
A meeting was later held with the countries of the English-speaking Caribbean, in which a declaration similar to the Caracas Declaration was adopted first in Devon, Barbados, and later at an expanded meeting that included Martinique.
Monitoring was another important element of the Regional Initiative for the Restructuring of Psychiatric Care in Latin America that bears mentioning.
A technical collaboration program was launched in almost every country in the Region, which lasted for several years in the s. As part of these processes, the Central America and Panama Action Group was created, which lasted for several years. A similar, shorter-lived group was created in the Andean subregion. Inthe work “Temas de Salud Mental en la Comunidad” [Mental Health Issues in the Community] was published and widely disseminated throughout the Hemisphere, particularly in universities and technical health schools.
Levav retired in Octoberand Dr. Some major events took place in In September, the PAHO Directing Council discussed and adopted a technical document and a resolution on mental health that, among other things, urged the Member States to:. Partnering for Progress,” which was held in Washington D. Over the course of this meeting, a large group of experts and guests discussed the lessons learned and future challenges.
Inthe World Health Organization WHO decided to launch a series of initiatives to put mental health on the global policy agenda and make it more visible throughout the world, and developed a set of extremely useful instruments and programs. The Pan American Health Organization PAHO joined WHO in these efforts and has been working diligently to develop policies, plans, and services and to update legislation on mental health and the promotion of human rights.
Another notable element in was a major project financed by the U. Three conferences were held as part of this project: Brazil, Mexico, and Jamaica Based in Panama, a consultant was appointed to advise the Central American countries, Mexico, and the Latin Caribbean. The Brasilia Declaration mentioned the new challenges that had become more evident over the past 15 years. Even though the new Declaration addressed already existing problems, no direct focus had been placed on these issues during the Caracas meeting, which centered more on reforming services and protecting the human rights of people with mental disorders.
These emerging issues, which had a tremendous social and heath impact, required appropriate responses from the health sector—and still do. Five major subject areas are mentioned:. From December and OctoberDr. Itzhak Levav was hired as a Temporary Adviser until a new unit chief was appointed. Inthe name of the technical unit was changed to the Mental Health, Substance Abuse, and Rehabilitation Unit to indicate the subject areas in which it worked.
In OctoberDr. Some of the most important elements of the period were:. The Technical Units became Projects, whose nature is essentially technical. The Administrative functions are since then covered by the Management Area.
A project known as “Mental Health, Disabilities and Rehabilitation” was created, which, in addition to mental health, included the component of physical and mental disability. The project was grouped under a new area: Technology, Health Care and Research.
The issue of alcohol and substance abuse was separated from mental health so it could be included in the Tobacco, Alcohol, and Substance Abuse Project, under the Sustainable Development and Environmental Health Area.
If we were to evaluate the historical development of mental health services in Latin America and the Caribbean, using the Caracas Declaration as a point of reference, marked progress would clearly be observed in the majority of countries.
Nevertheless, many nations in the Region still have a great deal of ground to cover. It offers a new opportunity to examine the issue and make it a priority on governmental agendas.
Develop National Mental Health Programs; Refocus mental health services from institutional to community settings ; Implement measures to control emotional disorders, epilepsies, and psychoses; Strengthen activities to promote the mental health prehhispanicos psychosocial development of children; Increase funding for mental health training programs; Improve legislation and regulations to protect human rights.
Antecedentrs was the coordinator of this program. Mental Health in the New Millennium Dr. In September, the PAHO Directing Council discussed and adopted a technical document and a resolution on mental health that, among other things, urged the Member States to: Strengthen the multisectoral approach to mental health; Promote family and community participation.
Five major subject areas are mentioned: Some of the most important elements of the period were: Dissemination of the Brasilia Principlesa programming document marking a major adjustment in the approach to restructuring mental health programs and services in the Region; Evaluation of the countries’ mental health systems using the prehispanixos of the Mdxico Health Organization’s Assessment Instrument for Mental Health Systems WHO-AIMS ; Emphasis on technical support for countries so that they can meet appropriate achievement levels in the implementation of their National Mental Health Plans; Strengthening technical cooperation in child and adolescent mental health.
New publications were also released: La Reforma de los Servicios de Salud Mental: Between andthe Regional Program on Mental Health decentralization policy was strengthened, and two new subregional advisers were appointed, one in Argentina to cover South America and another in Barbados to cover the English-speaking Caribbean.